This Cancer Prevention, Control and Population Sciences Career Development Award (K07) will allow the candidate to evaluate and improve the delivery and utilization of colorectal cancer screening services. In the research component, the candidate will conduct a prospective cohort study to assess the facilitators and barriers to colorectal cancer screening in the primary care clinical setting using an established behavioral model of preventive health care. The candidate will apply the principles learned from this K award toward his long-term goal: of becoming a productive independent investigator in the field of cancer prevention and control. The career development plan concentrates on a diverse set of tutorials directed by experts in cancer screening, patient and provider behavior change, adherence to medical care recommendations, outcomes research, and informed decision making and advanced coursework focused on health care guidelines, health care delivery systems, and use of multimedia for the clinical setting. The mentored research project addresses the need to improve colorectal cancer screening rates. The specific aims of the research proposal are (1) to describe the frequency with which health care providers appropriately recommend and patients complete colorectal cancer screening tests, (2) to identify patient, provider, and system factors associated with appropriate provider recommendation and patient completion of colorectal cancer screening tests, (3) to assess the patient-provider interaction by determining the association between the use of informed decision making in the clinical encounter with a provider recommendation and patient completion of these recommended tests, and (4) to develop and pilot test a multifaceted patient, provider, and systems level intervention to motivate providers to appropriately recommend colorectal cancer screening tests and patients to adhere with these recommendations. These issues will be examined in two phases. In phase I, aims 1-3 will be addressed in a prospective, cohort study of patients age 50-70 years at one academic, one community, and one VA clinical site. Survey research methods and analysis of audiotaped clinical visits will be applied in phase I. Findings from phase I will guide the development of a multifaceted intervention during phase II (aim 4). At the end of the project, the candidate will be prepared to obtain the extramural funding required to implement the intervention in a multi-center trial as well as designing behavior change interventions for other cancer screening strategies.